• The health care needs of most adults can best be met by a well-trained general internist. In the 1990s, general internists will find a surplus of specialists and subspecialists and an aging population. One of their major concerns will be controlling health care costs using a number of different strategies. Two of the major methods to control costs will be to place a greater emphasis on ambulatory care and to avoid hospitalization of patients whenever possible. To best prepare general internists, residency program directors will need to improve education in clinical practice by including more teaching in continuity of care in ambulatory settings, improved teaching of new content for practice, and increasing the number of program graduates entering practice as general internists.